Investigations unit REPORTING form

Please complete the form below to report your concerns to us directly. You can also call the Integrity Hotline at 1-800-884-0911 and provide a thorough explanation of your concerns over the phone.

* indicates a required field

Georgia law may provide whistleblower protection for city employees who report wrongdoing. See Official Code of Georgia Annotated section 45-1-4. Please note that although the Investigations Unit will not affirmatively publish names and other contact information, such information could become public after the investigation is complete.

Contact InformationYour contact information is optional, but we frequently need to contact people for additional information.

Name *

First

Last

Email Address *

xxxxxx@xxx.com

Street Address *

Address Line 2 *

City *

State *

Zip Code *

County *

* Indicates required field

Are you a city employee? *

YesNo

If so, what department? *

Home Phone *

Preferred Number *

Work Phone *

Cell Phone *

Name(s) of person(s) and department involved in alleged wrongful act or omission

Subject Name *

Position/Title *

Department *

Street Address *

Address Line 2 *

City *

State *

Zip Code *

The events or circumstances could represent a violation of: *

If Other, please explain briefly *

Summary of the facts relevant to the alleged wrongful actions *

Information that is helpful includes: What is the problem? Who is involved? When, where and why did it happen?

List the city, county, and state where the alleged wrongful actions took place *

Has this information been filed with any other agency or investigative entity? *

YesNo

If Yes, what is the name of the agency? *

Date Filed *

*

*

List any action taken by that agency *

Has a lawsuit and/or administrative grievance been filed against this department/individual based on the information provided in this report? *

YesNo

If yes, what is the name of the court and status of the case? *

Are there any documents regarding the alleged wrongful act or omission? (i.e., contracts, memos, letters, evaluation forms, minutes of meetings, etc.) If so, describe and/or attach them to this form. *

Attach Relevant DocumentsEach reporting form is limited to three attachments. If you have more than three attachments, please submit additional form(s) as needed.

Upload File *

Max file size: 20MB

Upload File *

Max file size: 20MB

Upload File *

Max file size: 20MB

Provide the name(s) of other people we may contact with knowledge of the alleged wrongful act or omission. *

May we refer the information you provided to the appropriate agency if necessary? Once referred, you may be contacted by that agency. *

YesNo

If the information you provide is referred to another agency, do you want your name and contact information removed? *